Northern Ireland's chief nursing officer has warned that the health service cannot continue its heavy reliance on agency workers to bolster staffing levels.
Professor Charlotte McArdle also said that unless a health transformation programme is up and running within the next two to three years the already under-pressure health system will be in significant difficulties.
The Press Association recently revealed that cash-strapped health trusts were being charged up to £100,000 for some agency nurses to address acute shortages of permanent staff.
It emerged that the cost of an uncontracted agency nurse could be up to four times more than that of a staff nurse.
In some cases, agency nurses are costing more than a consultant's salary.
"We will always be reliant on agency staff due to unplanned sickness, maternity leave etc, but not at the levels we are at the moment.
"This year will be difficult but once we see an increase in overseas staff and students coming through, that should hopefully start to turn around. But we cannot continue in the model we are currently working in. We need the transformation programme.
"If we continue with the current system we are always going to run out of nurses because supply cannot keep up with demand. We need to transform the health service and make sure we have staff of whatever kind," said Professor McArdle.
Transforming Your Care - an ambitious 10-year plan to make Northern Ireland's health and social care system fit for the 21st Century - was unveiled by then health minister Michelle O'Neill in 2016.
However, with the collapse of the Stormont powersharing government there has been little progress implementing the plan.
"If we don't get a transformation programme up and running over the next two to three years we will be back in significant difficulties," said Professor McArdle.
"The way services are organised is out of date and not delivering the way we want it to and therefore existing capacity cannot meet the ever-rising demand.
"Transformation of health and social care is the answer, and indeed is the only way forward," she added.
Professor McArdle said while the absence of a health minister is not impeding ability to get work done, she warned that one is needed to help make longer term decisions.
Describing the health system as being under pressure she added that "superb" nursing staff are being asked to work harder and harder in difficult circumstances.